FRACTURES - LONG ANSWER NOTES (ORTHOPEDICS)
1. INTRODUCTION
A fracture is defined as a break in the continuity of a bone, either complete or incomplete. It results from a force
exceeding the bone's strength. Fractures may be traumatic, pathological, or stress-related. Proper classification,
diagnosis, and treatment are essential for optimal bone healing and function.
2. CLINICAL FEATURES
- Pain: Sudden and localized.
- Swelling: Due to hematoma and soft tissue injury.
- Deformity: Angular, rotational, or shortening of the limb.
- Tenderness: Over the site of fracture.
- Crepitus: Grating sensation on movement.
- Abnormal mobility: Movement at an unusual point.
- Loss of function: Inability to use the affected limb or bear weight.
- Wound or bleeding: In open fractures.
- Neurological/Vascular symptoms: Numbness, cold limb, absence of distal pulses.
3. CAUSES
- Traumatic: Most common; RTA, fall, assault.
- Pathological: Bone weakened by infection, tumors, osteoporosis.
- Stress: Repetitive microtrauma, e.g., athletes, military.
- Congenital: Fragile bones, as in osteogenesis imperfecta.
4. CLASSIFICATION OF FRACTURES
A. Based on skin involvement
- Closed (Simple): Skin intact.
- Open (Compound): Bone protrudes through the skin.
B. Based on completeness
- Complete: Bone is broken through its entire thickness.
- Incomplete: Partial break (e.g., greenstick).
C. Based on fracture pattern
- Transverse, Oblique, Spiral, Comminuted, Segmental, Avulsion, Impacted.
D. Based on displacement
- Undisplaced, Displaced (angulated, rotated, overriding).
E. AO Classification
- Based on location, type, and morphology.
F. Salter-Harris (for growth plate fractures)
- Type I to V: Physis involvement in varying combinations.
5. INVESTIGATIONS
A. Clinical Evaluation
- History, physical exam, neurovascular status.
B. Imaging
- X-ray (2 views), CT scan (complex), MRI (soft tissue), Bone scan, Blood tests.
6. GENERAL TYPES OF FRACTURES
- Closed, Open, Comminuted, Greenstick, Stress, Impacted, Avulsion.
7. SPECIAL NAMED FRACTURES
- Colles', Smith's, Pott's, Boxer's, Jefferson's, Monteggia, Galeazzi, Bennett's, Le Fort, Hangman's, Pathological.
8. GENERAL TREATMENT
A. Initial Management
- Immobilize, control pain and bleeding, ABCDE assessment.
B. Reduction
- Closed or open reduction.
C. Fixation
- Internal (plates, screws), External (rods, pins).
D. Immobilization
- Casts, braces, traction.
E. Rehabilitation
- Physiotherapy, ROM exercises, gradual mobilization.
9. COMPLICATIONS
- Early: Shock, embolism, compartment syndrome, infection.
- Late: Malunion, nonunion, AVN, stiffness, growth disturbance.
10. PRINCIPLES OF MANAGEMENT
- Recognition, Reduction, Retention, Rehabilitation.
